Because Life with Still's Can Still Be Life

Poor Veins For IVs and Blood Tests?

I’d been planning to write a blog post on this topic for a while as it has become a major concern for me over time, especially since starting Orencia infusions in June. Then a converstion on twitter yesterday confirmed that it is something that an increasing number of us have to think about, now that so many of the treatments prescribed for Still’s Disease (and similar conditions) are Intravenous, meaning that they are administered through a vein.

Intravenous drugs you may have heard of in Still’s treatment include:

MabThera (Rituximab)

Remicade (Infliximab)

Orencia (Abatacept)

RoActemra (Tocilzumab)

IV Ig Immunoglobulin Therapy

Over the past fifteen years I have had countless IVs – Two years of Immunoglobulin therapy (3 days a month), Blood transfusions, Heparin, Saline fluid replacement, IV Steroids, Antibiotics and Anti-Histamines, General Anaesthesia… basically, multiple hospital stays that required intravenous access for one reason or another. Add to that, the fact that most of the medication I have been on throughout this time has required either fortnightly or monthly blood monitoring, and you can see it has been pretty tough on my veins.

And I know this has been the case for others too.

At some point, I realised that it was getting harder for them to find a good vein; in fact, I was left with only two ‘good’ ones in the crux of my right elbow. When things were spaced apart it wasn’t too bad, they could usually recover enough between blood tests to be usable again, but multiple blood tests and cannulation during hospital stays became a nightmare. One particularly worrying experience happened when I went down to theatre for my last surgery and even the anaesthetist couldn’t get a cannula in. He ended up knocking me out with gas instead and I woke from the surgery with a cannula near my clavicle, which wasn’t too bad that time but I wouldn’t want to be awake for them to try it!

Since then, I’ve had doctors and nurses try all sorts of strange places to draw blood or insert an IV; from thumbs and wrists, to palms and forearms, usually taking numerous attempts before finding success. Every hospital stay it becomes an issue and I am filled with dread – I can deal with most prods, pokes and pains, but for some reason the thought of them having to cannulate anywhere but my arms fills me with fear.

And now, with only one working vein, the Orencia infusions are becoming a worry to me because each time so far there has been resistance in the line and we’ve struggled getting the infusion through. What will happen if this one gives up also? I dread to think, but there are certain things that we all can try to improve our chances of providing a good vein frst time:

Tips to Boost Veins for Blood Tests and IV Cannulation

Stay hydrated – make sure you drink plenty of fluids before you are due to have your infusion or blood test to pump up those veins. Start this at least a few days beforehand if you can and limit the amount of caffiene you drink too, as this only dehydrates veins.

Stay warm – if you are cold, your veins will constrict and be much more difficult to find. I’ve even known nurses to advise placing a hot compress on the area to be cannulated to dilate veins.

Rotate sites if possible to give veins chance to recover, keep track of which vein is used and when.

Advise the nurse / doctor if you know a certain site is not productive, rather than let them try and be unsuccessful. You know your body better than anyone and it will save you some bruises.

Ask for a phlebotomy nurse when possible, as they have much more experience in finding difficult, deep veins that others might miss. They do it all day every day after all!

Ask them to use the smallest needle they can; although this will depend upon what is being infused.

Relax and make sure you are comfortable; don’t look at the needle, it may be an ‘old nurses’ tale but some say that veins retract when a patient watches, even if you think it doesn’t bother you.

I’ve read that hand strengthening exercises can boost veins in the arms; I’m not sure how much truth there is in this one but I’m going to buy one of those stress balls to squeeze just in case!

Also, doing some simple stretches / arm exercises prior to cannulation can help get the blood flowing and warm up the limb, although with painful joints this is not always possible.

Finally, dangling your arm over the edge of the bed/chair for ten minutes beforehand will allow gravity to increase blood flow to the limb.

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I know that these tips won’t work for everyone but they’re certainly worth a try; I will definitely be giving some of them a go to conserve my remaining vein, maybe I’ll even find a couple that have been hiding. If anyone else has any advice please let me know and I’ll add it to the list.

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6 Responses

What excellent advice, L. THANK you. I’ve copied this post so that I can refer to it before my next blood-letting. Like most people with autoimmune diseases, I get stuck frequently and have many once-good veins that have since collapsed. These days, the phlebotomist usually uses the veins on the back of my hands. I’m not squeamish at all, but I hate that because it hurts. Your advice is solid and I’ll use it.

Hope this finds you feeling well and, with luck, not like a pincushion. Walk in peace.

Thank you Wren, I’m glad you found it useful! I’d been scouring the net for advice on this and could only find bits and bobs – I thought it might help to put it all in one place for others to refer to. Like you, many of my veins have collapsed, there are none visible in my left arm/hand at all and it seems the places left to cannulate get more painful so I completely empathise. I hope the tips do help to conserve our remaining veins – maybe I need to look at helping them heal too?
Take care
L x

I understand the frustration. I found a product that is used by some EMS systems called Veinlite (www.veinlite.com). There are several models, ranging in price from 179.00 up, but I would gladly pay that if it helped. The device is a handheld vein locator. It uses orange and red LEDs and illuminates the veins. There is a pediatric version, and EMS version and then the office use version. The number of LEDs varies depending on the unit. Might be worth talking to the doctors office about, or purchasing yourself if allelse fails.

i really struggle with problems with my veins for draws.. I have a rare form of vasculitis, so my veins are crappy to begin with, but then after having so many pricks and pokes, they are even worse.. sometimes drs will consider a port for stubborn cases, but I really dont want one… even tho I have nasty reactions to blood draws and it would probably make my life easier in the future.

It’s funny, after posting my latest blog update I read about your troubles with the blood nurse and it sounded very familiar! A port was mentioned to me a while ago during a hospital stay when they quickly used and abused my good vein; I had hoped things were improved since then though. I even relented and let someone look at my feet but I have a lot of valves / junctions, so they’re not great either.

It really makes the blood draws and iv’s much nastier than they are already.
Even tho my condition is vascular, i know a lot of other people with inflammatory or auto immune conditions that have the same problems. It sounds like theres almost no avoiding it – just understanding.. but that still doesnt work when you get stubborn or ignorant nurses!!
we end up looking like junkies by the time all is said and done 😛 I just found out I need more blood drawn today too – goody! now the other arm can have matching track marks..

My Still’s Life

My name is Laura and I was diagnosed with Still's Disease at the age of 19, with previous diagnoses of Dermatomyositis at 14 and Post-Viral Reactive Arthritis at the age of 3. Life is a bit of a rollercoaster to say the least, but I'm happy to say that I have had my fair share of highs with the lows. I have currently been off work for over 18 months due to a severe flareup and was getting bored, so I thought that I would try and put my mind to something constructive.

I have tried numerous drugs to treat my Still's over the years, including:

Unfortunately, having one autoimmune disease can lead to other health problems and I have also developed Hidradenitis Suppurativa, Gastritis, Anaemia of Chronic Disease, MVP, PCOS and Migraine, which I post about from time to time.

Happy reading :)

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Toughness is in the soul and spirit, not in muscles.

~Alex Karras

The block of granite which was an obstacle in the pathway of the weak, became a stepping-stone in the pathway of the strong

~ Thomas Carlyle

Strength does not come from physical capacity. It comes from an indomitable will.

~ Mahatma Gandhi

You gain strength, courage, and confidence by every experience in which you really stop to look fear in the face. You are able to say to yourself, 'I lived through this horror. I can take the next thing that comes along.'